Tough Times Call for Technology

December 15, 2009

An EMR purchase is a business decision like any other. It’s an expensive decision, true, and it requires change. But it’s still just a business decision. What questions should you really be asking yourself?


A family physician with a gray beard and stooped shoulders shyly approached me at a meeting last week. Out of the corner of his mouth, he asked about EMRs. He knew the new economic stimulus package includes incentives to physicians; should he act now?

But he wasn’t really interested in my answer. He’d already decided not to buy an EMR and his real purpose was to explain why: Since EMRs improve documentation, and since better documentation tends to increase physician reimbursement, the federal government will actually end up paying more for healthcare as more physicians adopt EMRs, not save money through improved efficiencies. Therefore it will eventually have to cut reimbursement further, so he won’t get an EMR himself.

In other words, “There’s no real financial incentive to improving my practice’s efficiency because Uncle Sam will just penalize me later. So why bother?” But his unassailably circular logic misses the point: An EMR purchase is a business decision like any other. It’s an expensive decision, true, and it requires change. And change is scary. I get it. But it’s still just a business decision, meaning it’s best to leave the emotions and politics out of it.

My grumpy new friend isn’t the only one struggling with this. Pragmatic physicians, trained to see a problem and drill to a solution, wax philosophic when it comes to business, and especially technology. Do EMRs improve clinical outcomes or just maintain the status quo? Can an economic stimulus payment really spur adoption?

These are all fine questions, but I say let the researchers and the policy wonks worry about them. The essential issue for you is whether your practice would run more efficiently over the long term with electronic records or without them. Frankly, I think this question all but answers itself. Of course you’d be better off, assuming you do all the other things more or less correctly like picking the right vendor for your practice and having a well-executed transition plan. After that it’s a matter of measuring benefits against costs: Would you be better off enough to justify the expense? Again, I think that for most practices the answer was yes even before the stimulus. Now? It’s a no-brainer, especially when you consider the reimbursement reductions the government is already planning for intractable EMR holdouts.

The stimulus package promises payments in the $40,000 range to physicians who can demonstrate use of certified EMRs, starting in 2011. (Learn more about the stimulus payments by typing “stimulus” into the search engine at PhysiciansPractice.com.) Even more importantly, it posits that physicians who aren’t using an EMR will shortly thereafter see a reduction in payments from Medicare.

There’s no sense debating the merits of such a plan. It’s done. See if you can take advantage of it by having an EMR in place by 2011. One hint: You better start shopping now. Making a decision and implementing the technology takes some time.

Similarly, if you’ve been procrastinating on getting a revenue cycle management product or upgrading your practice management system, there may be no time like the present. Some 2 million people are expected to lose their jobs this year. That includes a lot of your patients, who will be losing health benefits. You should be requiring preverification for every patient, and technology is the only way to make that happen effectively.

Time is running short for many small practices. The cost of business is up. Reimbursement isn’t going to change short-term. Walgreens, CVS, and other retail clinics stand ready to take your patients if you can’t adapt. The world is changing - quickly. It’s time to stop pretending that you don’t have to.

The plummeting economy should have added a sense of urgency but instead seems only to have added panic. Many practices just seem paralyzed by their own inertia. Now is the time for flexibility, speed, and practical decision making.

So, to action. Consider this guide a different sort of stimulus: one for sensible solutions. Some are big, some are small, but all are just business. Focus now on trimming waste and boosting revenue. Save the moralizing for better times.

Pamela L. Moore is director of content and strategy for Physicians Practice. She can be reached at pam.moore@cmpmedica.com.

This article originally appeared in the 2009/2010 Physicians Practice Technology Guide.